前房成形联合脉络膜上腔放液术治疗青光眼滤过性手术后睫状体脉络膜脱离

目的：探讨前房成形联合脉络膜上腔放液术治疗青光眼滤过性手术后睫状体脉络膜脱离的有效性。

方法：选取2008-07/2012-02在唐山市眼科医院行青光眼滤过性手术后发生睫状体脉络膜脱离患者95例95眼,适时采用前房成形术联合脉络膜上腔放液术治疗,术后观察患者眼压、视力、前房深度及超声生物显微镜测量脉络膜上腔间隙。

结果：术后观察患者眼压、视力、前房深度及睫状体脉络膜上腔间隙,前房成形术联合脉络膜上腔放液术治愈率达86%,有效率达96%。

结论：前房成形术联合脉络膜上腔放液术是治疗青光眼滤过性手术后睫状体脉络膜脱离的有效方法。     

青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼

目的探讨青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼的发病机制、临床特点及预防。方法对4例（4只眼）青光眼滤过术后合并睫状体脉络膜脱离的恶性青光眼患者的临床资料进行回顾性分析。结果 4例（4只眼）在术后早期即出现Ⅱ°、Ⅲ°浅前房,通过眼底检查、手术及超声生物显微镜（UBM）检查发现睫状体脉络膜脱离、睫状环阻滞,经睫状体脉络膜上腔放液,并根据病情联合玻璃体水囊抽吸、前段玻璃体切除以及晶状体手术等,所有患眼眼压均恢复正常,前房加深,脉络膜脱离消失。结论睫状体脉络膜脱离是发生恶性青光眼的诱发因素,预防睫状体脉络膜脱离是预防恶性青光眼发生的关键;对术后早期即出现的Ⅱ°、Ⅲ°浅前房,及时进行UBM检查有助于明确诊断,可减少治疗的盲目性。     

青光眼滤过术后恶性青光眼合并睫状体脉络膜脱离

目的：探讨青光眼滤过术后恶性青光眼合并睫体脉和膜脱离的特点及治疗方法。方法：对10例12只青光眼小梁切除术后恶性青光眼合并睫状体脉络膜脱离的临床资料作回顾性分析。结果：4只眼经1－3次脉络膜上腔放液联合抽玻璃体水囊联合前房注气术后，3只眼压恢复正常，1只眼前房不恢复，改行前部玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术。其余8只眼均一次行前 部玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术，眼压控制正常，前房形成.结论：青光眼滤过术后恶性青光眼合并睫状体脉络膜脱离为难治并发症。脉络膜上腔放液联合抽玻璃体水囊治疗有效，前玻璃体切除联合超声乳化白内障吸除及人工晶状体植入术可提高一次手术成功率。     

抗青光眼术后浅前房的前房重建手术

目的 探讨青光眼滤过术后浅前房的手术方法和效果.方法 取17例抗青光眼术后浅前房患者经保守治疗无效,有7只眼发生脉络膜脱离,5只眼行脉络膜上腔放液+前房成形术,1只眼行白内障超声乳化及人工晶状体植入术及前房成形术,1只眼行脉络膜上腔放液+白内障超声乳化及人工晶状体植入术+前部玻璃体切割术+前房成形术.有9只眼发生恶性青光眼,1例行抽玻璃体水囊联合前房成形术,3例行前部玻璃体切除及后囊切开联合小梁切除及丝裂霉素联合白内障超声乳化及人工晶状体植入及房角分离术,1例行前部玻璃体切除术中发生脉络膜脱离及脉络膜上腔出血行前部玻璃体切除联合玻璃体腔放液,2只眼行前部玻璃体切除联合白内障超声乳化及人工晶状体植入及房角分离术,1例行前部玻璃体切除联合前房成形术,术后前房仍浅又行白内障超声乳化及人工晶状体植入及后囊膜切开及房角分离术,1例为视网膜脱离术后硅油存留眼行白内障超声乳化联合虹膜周边切除术及前房成形术.结果 术后前房恢复时间脉络膜脱离组行脉络膜上腔放液及前房成形术平均为5.6d,恶性青光眼组行白内障超声乳化及人工晶状体植入术联合前部玻璃体切除及后囊切开组前房恢复时间最短,平均为1.1d.结论 恶性青光眼组行白内障超声乳化及人工晶状体植入术联合前部玻璃体切除及后囊切开治疗有效快速.     

青光眼滤过术后浅前房的临床分析

目的:讨论青光眼术后浅前房形成的常见原因及处理方法。方法:回顾性总结甘肃省庆阳市人民医院1990-01/2009-06期间连续收治住院的358例501眼青光眼住院患者行青光眼滤过性手术后发生前房的原因、类型及处理方法。结果:共行青光眼滤过性手术501眼,其中118眼发生浅前房,发生率为23.6%。小梁切除术21.2%,小梁切除+MMC35.2%、青光眼联合白内障的三联手术10.9%。浅前房发生时间在术后1～7d,其中房水滤过过强47眼(39.8%),睫状体脉络膜脱离33眼(28.0%),结膜瓣渗漏27眼(22.9%),恶性青光眼8眼(6.8%),恶性青光眼合并睫状体脉络膜脱离1眼(0.8%),脉络膜上腔出血2眼(1.7%),除恶性青光眼外其余均伴有术后低眼压。需要手术治疗才能恢复前房37眼,其余81眼仅通过保守治疗均恢复前房。结论:青光眼术后浅前房发生率高,其常见的原因是房水滤过过强、睫状体脉络膜脱离及结膜瓣渗漏。通常发生在术后1～2d。以小梁切除+MMC术后浅前房发生率高,MMC不但阻止滤过泡的纤维化,而且能使房水分泌减少。大多数浅前房可通过保守治疗治愈,必要时须采取手术干预。     

青光眼滤过术后浅前房的临床探讨

目的 讨论青光眼滤过术后浅前房形成的常见原因及处理方法。方法 回顾性总结北京同仁医院青光眼组1998年10月～1999年10月期间连续收治的352例青光眼住院患者行青光眼滤过性手术后发生浅前房的原因、类型及处理方法。结果 共行青光眼滤过性手术495只眼，其中117只眼发生浅前房，发生率为23．64％。小梁切除术为19．2％(15／78)，小梁切除术 MMC为32％(93／291)，青光眼联合白内障的三联手术为7．1％(9／26)。浅前房发生在术后1～7天，其中滤过过畅36只眼(30．77％)、睫状体脉络膜脱离34只眼(29．06％)、结膜瓣渗漏27只眼(23．08％)、恶性青光眼15只眼(12．8％)、恶性青光眼合并睫状体脉络膜脱离3只眼(2．56％)、脉络膜上腔出血2只眼(1．71％)。需要手术治疗的35只眼，其余82只眼仅通过保守治疗均能恢复前房。结论 青光眼滤过术后浅前房发生率较高，其常见原因是房水滤过过畅、结膜瓣渗漏及睫状体脉络膜脱离。以小梁切除术 MMC的发生率最高，MMC不但能阻止滤过泡的纤维化，而且能使房水分泌减少。大多数浅前房可通过保守治疗治愈。     

青光眼小梁切除术后脉络膜脱离的原因及防治

目的 探讨青光眼小梁切除术后脉络膜脱离的原因及防治方法 .方法 对242例(269眼)青光眼小梁切除术后发生的28例(32眼)脉络膜脱离进行回顾性分析.结果 28例(32眼)脉络膜脱离发生时间为术后1～5d,平均(3.21±1.22)d,术后脉络膜脱离的发生与术前眼压控制不佳、术中切口偏后及巩膜瓣偏薄有关.通过散瞳、抗炎、加压包扎、应用皮质类固醇及高渗剂等治疗而复位,1例Ⅲ度浅前房行脉络膜上腔放液前房形成而复位,均经UBM检查证实脉络膜下积液吸收.结论 青光眼小梁切除术后脉络膜脱离与术前眼压高、术中手术操作不当有关.一般经保守治疗可得到治愈,而早期通过UBM检查发现并采取相应措施可避免严重并发症的发生.     

原发性闭角型青光眼眼部生物结构与术后浅前房的临床研究

目的:测量原发性闭角型青光眼的眼生物结构并探讨其与术后浅前房的关系。方法:A超检查102眼闭角型青光眼和20只正常眼的眼结构。青光眼行小梁切除术,术后观察眼压、滤过泡、前房、虹膜切除口等。结果:102眼平均中央前房深度,相对晶状体位置,晶状体厚度,眼轴长度均与正常眼组有显著性差异。青光眼组中9眼各项数值较其它各眼也有明显差异。术后各眼眼压低于2.0kPa,平均眼压1.12±0.23kPa。41眼出现浅前房。Ⅱ级浅前房1wk未缓解或发展为Ⅲ级,根据浅前房形成原因,行脉络膜上腔放液、晶状体摘除术或人工晶状体植入术后前房形成。结论检查原发性闭角型青光眼的眼生物结构有助于选择适当术式,防止术后浅前房。     

青光眼术后浅前房的观察及处理

目的:探讨青光眼滤过术后浅前房的原因及处理方法。方法:回顾性分析298例462眼青光眼行滤过手术后发生浅前房的原因、类型及处理方法。结果:患者298例462眼中,浅前房99眼,浅前房发生率21.4%。小梁切除术358眼,浅前房77眼,发生率21.5%;小梁切除+MMC(丝裂霉素C)85眼,浅前房20眼,发生率23.5%;青光眼联合白内障超声乳化人工晶状体植入术19眼,浅前房2眼,发生率10.53%。浅前房发生的时间多在术后1～5d,其中滤过过强42眼,占42.4%,脉络膜睫状体脱离29眼,占29.3%;结膜瓣渗漏20眼,占20.2%,恶性青光眼6眼,占6.1%,恶性青光眼并睫状体脉络膜脱离2眼,占2.0%。79眼通过保守治疗恢复前房、20眼经手术治疗恢复前房。结论:浅前房的发生主要与术前高眼压、眼部炎症反应以及术后滤过强、结膜瓣渗透、脉络膜脱离有关,大多数浅前房通过保守治疗可治愈,必要时需手术干预。     

青光眼术后脉络膜脱离的临床诊治

脉络膜脱离是青光眼术后浅前房的原因之一,笔者收集了在本院2004年收住院行青光眼手术后发生浅前房的4例。现报告如下:本文4例患者年龄在55岁～73岁之间:男1例1眼,女3例4眼。发生脉络膜脱离时间为3眼术后一周内,2眼术后一月半。本文的4例5眼术前均经药物降眼压治疗,控制眼压正常后在局麻下行小梁切除术。本文3例表现为术后3d～5d出现I～II度浅前房,经眼压测定,B超及眼底检查排除恶性青光眼可能,确诊为脉络膜脱离。予美多丽眼液和1%阿托品眼膏散瞳、点典必殊眼液、口服醋氮酰胺片及静滴20%甘露醇、静推10%葡萄糖酸钙,静卧床休息等保守治疗…     

穿刺巩膜隧道植入Ahmed青光眼阀治疗难治性青光眼的疗效

目的:观察用23G针头直接穿刺制作巩膜隧道的方式植入Ahmed青光眼阀(Ahmed glaucoma valve,AGV)治疗难治性青光眼的临床疗效及并发症。方法:观察44例44眼难治性青光眼患者,应用23G针头直接穿刺制作巩膜隧道,行青光眼阀植入术进行治疗。观察患者术后眼压、视力、并发症,并与术前进行对比。结果:本组患者成功率84.1%。术前眼压:52.1±10.1mm Hg,最后一次随访眼压15.6±6.9mm Hg。视力提高者11眼,视力无改变者27眼,视力降低者6眼。并发症包括:浅前房4例,脉络膜脱离3例,引流管移位1例,前房积血6例,引流管阻塞1例,脉络膜驱逐性出血1例,引流盘包裹5例。结论:直接穿刺巩膜隧道的方法植入青光眼阀,手术操作简单可行,避免了制瓣及异体巩膜移植,并简化了手术操作,防止术后房水管周渗漏,术后浅前房发生率低,为切实可行的手术方法。     

XEN‐45 collagen implant for the treatment of uveitic glaucoma

Importance

The XEN‐45 implant, a hydrophilic collagen implant which drains aqueous to the subconjunctival space, has not been investigated in the context of uveitic glaucoma.

Background

To determine the safety and efficacy of the XEN‐45 collagen implant in eyes with uveitic glaucoma.

Design

Exploratory prospective case series.

Participants

patients with medically uncontrolled uveitic glaucoma.

Methods

Twenty‐four consecutive patients (mean age ± standard deviation [SD] = 45.3 ± 18.1 years) were implanted with the XEN‐45 implant.

Main Outcome Measures

The primary outcome measure was intraocular pressure (IOP) reduction at 12 months as compared to baseline. Secondary outcome measures included ocular hypotensive medication use at 12 months, the requirement for further glaucoma surgery and failure. Intraoperative and postoperative complications were documented.

Results

The baseline mean ± SD IOP was 30.5 ± 9.8 mmHg and the mean ± SD number of glaucoma medications required was 3.3 ± 0.8. In 20 eyes (83.3%) in whom conventional glaucoma surgery was originally perceived to be inevitable, further surgery was not required after XEN‐45 implantation. The mean IOP was reduced by 60.2% from baseline to 12.2 ± 3.1 mmHg and mean medication usage was reduced to 0.4 ± 0.9 at 12 months (both P < 0.001). One patient had hypotony persisting beyond 2 months that required surgical revision and one patient developed blebitis. The 12‐month cumulative Kaplan–Meier survival probability was 79.2%.

Conclusions and Relevance

The XEN‐45 implant is effective for the treatment of patients with medically uncontrolled uveitic glaucoma. Potentially sight‐threatening complications, including bleb‐related ocular infection and persistent hypotony, may occur.     

Translational neuroprotection research in glaucoma: a review of definitions and principles

The maintenance of vision, through prevention and attenuation of neuronal injury in glaucoma, forms the basis of current clinical practice. Currently, the reduction of intraocular pressure is the only proven method to achieve these goals. Although this strategy enjoys considerable success, some patients progress to blindness; hence, additional management options are highly desirable. Several terms describing treatment modalities of neuronal diseases with potential applicability to glaucoma are used in the literature, including neuroprotection, neurorecovery, neurorescue and neuroregeneration. These phenomena have not been defined within a coherent framework. Here, we suggest a set of definitions, postulates and principles to form a foundation for the successful translation of novel glaucoma therapies from the laboratory to the clinic.     

房角金环植入术治疗顽固性青光眼的临床观察

目的　观察房角金环植入术治疗顽固性青光眼的近期和中期疗效。方法　对29例(29只眼)药物难以控制的青光眼行房角金环植入术。结果　随访2～23月,平均73±53月。眼压由术前(5134±1369)mmHg降至术后(2659±1127)mmHg。总成功率为7241%,其中非新生血管性青光眼的成功率为7692%,新生血管性青光眼的成功率为3333%。并发症包括前房积血、浅前房、术后早期低眼压、前部葡萄膜炎、金环与角膜内皮接触、金环外露、渗出性脉络膜脱离等。结论　房角金环植入术是一种治疗顽固性青光眼的有效方法。     

Predictability of success for combined iStent inject trabecular bypass implantation with phacoemulsification in the subsequent eye

Background

To investigate in combined iStent inject implantation with phacoemulsification carried out bilaterally, whether intraocular pressure (IOP)-lowering effectiveness in the first eye has a predictive potential for the outcome of the second eye in primary open-angle glaucoma (POAG).

Methods

This retrospective study included 72 eyes from 36 participants, who underwent trabecular bypass implantation in combination with cataract surgery at two study centres (Düsseldorf, Cologne). Surgery was classified as either ‘success’ or ‘failure’ based on three scores: IOP at follow-up <21 mmHg (Score A) or IOP < 18 mmHg (Score B), with an IOP reduction >20% respectively, without re-surgery and IOP ≤ 15 mmHg with an IOP reduction ≥40%, without re-surgery (Score C).

Results

The IOP lowering outcomes of first and second eyes did not differ significantly. There was a significantly higher chance of success in the second eye after effective surgery in the first eye compared with cases after a preceding failure. Within our cohort, a 76% probability of success for the subsequent eye was determined following prior success for Score A. This probability was reduced to 13% if surgery in the first eye failed. The respective probabilities were 75% and 13% for Score B and 40% and 7% for Score C.

Conclusions

In bilateral trabecular bypass implantation combined with cataract surgery, there is a high predictive potential for subsequent eyes based on the extent of IOP-lowering in the initial eye, which should be considered by the surgeon for second eye surgeries.     

Phacotrabeculectomy in Treatment of Primary Angle-closure Glaucoma and Primary Open-angle Glaucoma

Purpose To evaluate the surgical outcome of combined phacoemulsification, posterior chamber intraocular lens implantation, and trabeculectomy (phacotrabeculectomy) in patients with primary angle-closure glaucoma (PACG) or primary open-angle glaucoma (POAG).Methods The records of 57 consecutive patients (65 eyes) with PACG or POAG that were treated with phacotrabeculectomy were reviewed retrospectively. There were 31 eyes with PACG and 34 with POAG. The mean follow-up period was 21.0 ± 8.3 months. The visual acuity, intraocular pressure (IOP), number of medications, and complications were evaluated.Results The mean IOP and the number of glaucoma medications decreased significantly after phacotrabeculectomy in both groups. The mean IOP reduction was significantly greater in eyes with PACG (P < 0.05). The absolute success rates were 87.1% and 70.6% in PACG and POAG, respectively. The difference in the success rates was not significant (P = 0.297). The early postoperative complication rates were similar in both groups.Conclusions Phacotrabeculectomy results in greater IOP reduction in eyes with PACG than in those with POAG, but the overall success rates were not significantly different. Jpn J Ophthalmol 2004;48:408–411 © Japanese Ophthalmological Society 2004     

Glaucoma in China

The motivation for this paper is that, having come from China, a country which had closed herself to the outside world for three decades, I thought it might be interesting to compare glaucoma in the two countries. Since I am from only a municipal hospital of a small city Hangzhow (a sister city of Boston), whatever I say can only be accepted as personal view points. Presently I have this wonderful opportunity to be a research fellow at the world wide famous Massachusetts Eye & Ear Infirmary, which is affiliated with Harvard Medical School. The comparison therefore may not be exactly appropriate but may help to see where my country stands, what we have, what we lack and what goals to strive for to better the health of China. There may be some confusing terms in this paper such as Liberation, Cultural Revolution, etc. Table 1 may help give a clearer conception.     

Glaucoma neuroprotection: What is it? Why is it needed?

The glaucomas are a group of ocular diseases characterized by progressive optic nerve damage and visual loss. Although there is good laboratory evidence for glaucoma neuroprotection by several drugs, the evidence from randomized clinical trials is lacking.     

Managing high risk glaucoma with the Ahmed valve implant: 20 years of experience

AIM: To estimate the efficacy and safety of the Ahmed implant in patients with high risk for failure after glaucoma surgery. METHODS: In 342 eyes of 342 patients with refractory glaucoma, even with application of medical treatment, the Ahmed valve was introduced for intraocular pressure (IOP) control, in the period of the last 20y. The nature of glaucoma was neovascular in 162 eyes, pseudophakic or aphakic in 49 eyes, inflammatory in 29 eyes and non working previous antiglaucomatic surgical interventions in 102 eyes. RESULTS: Follow-up ranged from 18 to 120mo with a mean follow-up of 63.2mo. IOP before the operation decreased from 31.6±10.4 mm Hg to 18.3±5.4 mm Hg (no systemic treatment) at the end of follow up period. When we compared the IOP values before the operation using ANOVA showed statistically significant difference (P<0.001). The success rate was 85.2% during the first semester, 76.8% at 12mo and 50.3% at the end of follow up period (18 to 120mo after implantation). Success rate was 25.7% in neovascular glaucoma, 63.2% in aphakic glaucoma and 73.8% in non working previous antiglaucomatic surgical interventions. Complications due to the implant were: serous choroidal detachment in 14.8%, blockage of the tube in 2.8%, malposition of the tube in 4.9%, suprachoroidal hemorrhage in 2.1%, cataract progression in 39.6% (phakic eyes), shallow anterior chamber in 9.2%, hyphaema in 28.9%, exposure of valve in 2.6%, exposure of tube in 9.3%, hypotony in 4.9% and conjunctival fibrosis in 41.5%. CONCLUSION: Despite the fact that Ahmed valve implant had suchlike results as other implants concerning the IOP control, complications rate due to hypotony or over filtration in the first days after the intervention are not that frequent as with other valve implants.